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Purpose Risk perception is an essential factor affecting how individuals evaluate risk, make decisions and behave. The impact of risk perception on customer purchase behavior has been widely studied; however, the association has been debated. Therefore, the purpose of this paper is to examine the relationship between risk perception and customer purchase behavior and to examine factors that could moderate it. Design/methodology/approach This study conducted a meta-analysis of this relationship and examined factors that could moderate it. Six databases were comprehensively searched. Two reviewers independently selected the studies for inclusion, extracted data and assessed quality. Pearson's r was used as the effect estimate. A total of 33 studies were included in the meta-analysis. Findings The results revealed a negative relationship between risk perception and customer purchase behavior. The geographical region, purchase channel and country development level affected the relationship. The correlation between perceived risk and purchase behavior in European consumers was the highest, followed by the correlation in American consumers; the weakest correlation was found in Asian consumers. For consumers in developed countries, perceived risk had a stronger negative influence on customer purchase behavior than that for consumers in developing countries. The perceived risk of online purchase channels had a stronger negative impact on customer purchase behavior than that of offline purchase channels. Research limitations/implications Risk perception is a useful context in which to explain barriers to customer purchase behavior. In addition, reducing consumers’ risk perception and perfecting the market transaction process with respect to buying behavior should be further studied. Originality/value The findings of this review indicate a direct negative relationship between risk perception and customer purchase behavior. To the best of the authors’ knowledge, this review is the first to meta-analytically summarize the impact of risk perception on customer purchase behavior in social sciences research, and it also illuminates new perspectives for future studies.

The relationship between diabetes mellitus and short-term exposure to extreme temperatures remains controversial. A systematic review and meta-analysis were performed to assess the association between extreme temperatures and diabetes mellitus morbidity and mortality. PubMed, Embase, the Cochrane Library, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched since inception to January 1, 2019, and updated on November 17, 2020. The results were combined using random effects model and reported as relative risk (RR) with 95% confidence interval (CI). In total, 32 studies met the inclusion criteria. (1) Both heat and cold exposures have impact on diabetes. (2) For heat exposure, the subgroup analysis revealed that the effect on diabetes mortality (RR=1.139, 95% CI: 1.089–1.192) was higher than morbidity (RR=1.012, 95% CI: 1.004–1.019). (3) With the increase of definition threshold, the impact of heat exposure on diabetes rose. (4) A stronger association between heat exposure and diabetes was observed in the elderly (≥ 60 years old) (RR=1.040, 95% CI: 1.017–1.064). In conclusion, short-term exposure to both heat and cold temperatures has impact on diabetes. The elderly is the vulnerable population of diabetes exposure to heat temperature. Developing definitions of heatwaves at the regional level are suggested.

Research indicates that air pollution is a risk factor of an increased occurrence of diseases. However, evidence is limited on the effects of the pollution index on disease and whether temperature modifies the effects. The objectives were (i) to explore the effects of the Air Pollution Index (API) and specific indices for pollutants (PM 10 , NO 2 , and SO 2 ) on respiratory emergency department (ED) visits in Beijing and (ii) to investigate whether temperature modified the effects of main air pollutants on respiratory ED visits. A quasi-Poisson generalized additive model was employed to examine the association of API and indices for pollutants with respiratory disease. Bivariate response surface model and stratification model (cold days, moderately cold days, moderately hot days, and hot days) were used to analyze the modification effects of temperature on air pollution and respiratory disease. The results showed that (i) the effects of API on respiratory diseases were similar to the index for PM 10 in Beijing. (ii) API and PM 10 were associated with increased respiratory ED visits on cold days and moderately cold days. Furthermore, the effects of PM 10 on respiratory disease on moderately cold days [Relative risk (RR) = 1.006 per 10 μg/m 3 , 95% CI 1.002–1.009] were stronger than on cold days (RR = 1.004 per 10 μg/m 3 , 95% CI 1.000–1.008). (iii) PM 10 (API) had a greater impact on children aged 10 to 17 years and females on moderately cold days, while the elderly had an increased risk of respiratory disease to PM 10 (RR = 1.008 per 10 μg/m 3 , 95% CI 1.002–1.013) and API (RR = 1.013 per 10, 95% CI 1.004–1.022) on cold days. In conclusion, temperature can modify the association between API and respiratory morbidity. A stronger correlation existed between PM 10 and respiratory diseases on moderately cold days, while the effects of cold days were less than that attributable to moderately cold days.

ObjectiveAdverse health effects of fine particles (particulate matter2.5) have been well documented by a series of studies. However, evidences on the impacts of black carbon (BC) or elemental carbon (EC) on health are limited. The objectives were (1) to explored the effects of BC and EC on cardiovascular and respiratory morbidity and mortality, and (2) to verified the reliability of the meta-analysis by drawing p value plots.DesignThe systematic review and meta-analysis using adapted Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach and p value plots approach.Data sourcesPubMed, Embase and Web of Science were searched from inception to 19 July 2021.Eligibility criteria for selecting studiesTime series, case cross-over and cohort studies that evaluated the associations between BC/EC on cardiovascular or respiratory morbidity or mortality were included.Data extraction and synthesisTwo reviewers independently selected studies, extracted data and assessed risk of bias. Outcomes were analysed via a random effects model and reported as relative risk (RR) with 95% CI. The certainty of evidences was assessed by adapted GRADE. The reliabilities of meta-analyses were analysed by p value plots.ResultsSeventy studies met our inclusion criteria. (1) Short-term exposure to BC/EC was associated with 1.6% (95% CI 0.4% to 2.8%) increase in cardiovascular diseases per 1 µg/m3 in the elderly; (2) Long-term exposure to BC/EC was associated with 6.8% (95% CI 0.4% to 13.5%) increase in cardiovascular diseases and (3) The p value plot indicated that the association between BC/EC and respiratory diseases was consistent with randomness.ConclusionsBoth short-term and long-term exposures to BC/EC were related with cardiovascular diseases. However, the impact of BC/EC on respiratory diseases did not present consistent evidence and further investigations are required.PROSPERO registration numberCRD42020186244.

Background High prices of medical consumables pose a major barrier for patients. To address those inflated prices, the National Healthcare Security Administration of China implemented the Centralized Volume-Based Procurement policy (CVBP) in 2021. However, evidence assessing the effect of CVBP in Gansu is insufficient. This study aims to estimate the impact of CVBP for high-value medical consumables in Gansu on the hospitalization expenses. Methods Data from 8076 inpatients in Gansu who underwent surgeries involving coronary stents, artificial joints, or intraocular lenses between April 2019 and October 2024 were collected. An interrupted time series analysis (ITSA) was conducted to examine the effect of CVBP on patient hospitalization expenses. An autoregressive integrated moving average (ARIMA) model was used to assess the difference between the predicted and actual expenses after the implementation of CVBP. Results (i) After implementation, the material expense per patient who underwent surgeries involving artificial joints was reduced by 387.782 Chinese yuan (CNY) ( 95%CI : −592.583 to −182.981, p  < 0.001) per capita per month. The material expense of patients decreased immediately by 18,668.870 CNY ( 95%CI : −24,241.620 to −13,096.120, p  < 0.001) per capita in the month when CVBP for coronary stents was implemented. The expense changes for intraocular lenses were not statistically significant. In addition, an immediate upward trend of 0.022 CNY per capita per month ( 95%CI : −0.017 to 0.026, p  < 0.05) after the implementation of CVBP in terms of the percentage of anesthesia expenses was observed in the post-intervention month. (ii) The results of the ARIMA predictions indicated that per capita material expense savings at months post-CVBP were 14,028.187 CNY for coronary stents, 24,476.634 CNY for artificial joints and 280.039 CNY for intraocular lenses. Conclusions The implementation of the CVBP of high-value medical consumables saved patient hospitalization expenses and material expenses in Gansu, China. Future research should analyze the long-term effects of CVBP on medical insurance funds and total health expenses.

The objective was to assess the transient association between air pollution and cardiac arrhythmia. Five databases were searched for studies investigating the association between daily increases in air pollutants (PM2.5, PM10, carbon monoxide, nitrogen dioxide, sulfur dioxide and ozone) and arrhythmia hospitalization or arrhythmia mortality. Two reviewers independently selected studies, extracted data, and assessed risk of bias. Outcomes were analyzed via a random-effects model and reported as relative risk and 95% confidence interval. 25 studies satisfied our inclusion criteria and 23 contributed to the meta-analysis. Arrhythmia hospitalization or mortality were associated with increases in PM2.5 (RR = 1.015 per 10 μg/m3, 95% CI: 1.006–1.024), PM10 (RR = 1.009 per 10 μg/m3, 95% CI: 1.004–1.014), carbon monoxide (RR = 1.041 per 1 ppm, 95% CI: 1.017–1.065), nitrogen dioxide (RR = 1.036 per 10 ppb, 95% CI: 1.020–1.053), and sulfur dioxide (RR = 1.021 per 10 ppb, 95% CI: 1.003–1.039), but not ozone (RR = 1.012 per 10 ppb, 95% CI: 0.997–1.027). Both particulate and gaseous components, with the exception of ozone, have a temporal association with arrhythmia hospitalization or mortality. Compared with Europe and North America, a stronger association was noted in Asia.

Background:Living evidence (LE) synthesis refers to the method of continuously updating systematic evidence reviews to incorporate new evidence. It has emerged to address the limitations of the traditional systematic review process, particularly the absence of or delays in publication updates. The emergence of COVID-19 accelerated the progress in the field of LE synthesis, and currently, the applications of artificial intelligence (AI) in LE synthesis are expanding rapidly. However, in which phases of LE synthesis should AI be used remains an unanswered question.Objective:This study aims to (1) document the phases of LE synthesis where AI is used and (2) investigate whether AI improves the efficiency, accuracy, or utility of LE synthesis.Methods:We searched Web of Science, PubMed, the Cochrane Library, Epistemonikos, the Campbell Library, IEEE Xplore, medRxiv, COVID-19 Evidence Network to support Decision-making, and McMaster Health Forum. We used Covidence to facilitate the monthly screening and extraction processes to maintain the LE synthesis process. Studies that used or developed AI or semiautomated tools in the phases of LE synthesis were included.Results:A total of 24 studies were included, including 17 on LE syntheses, with 4 involving tool development, and 7 on living meta-analyses, with 3 involving tool development. First, a total of 34 AI or semiautomated tools were involved, comprising 12 AI tools and 22 semiautomated tools. The most frequently used AI or semiautomated tools were machine learning classifiers (n=5) and the Living Interactive Evidence synthesis platform (n=3). Second, 20 AI or semiautomated tools were used for the data extraction or collection and risk of bias assessment phase, and only 1 AI tool was used for the publication update phase. Third, 3 studies demonstrated the improvement in efficiency achieved based on time, workload, and conflict rate metrics. Nine studies applied AI or semiautomated tools in LE synthesis, obtaining a mean recall rate of 96.24%, and 6 studies achieved a mean F1-score of 92.17%. Additionally, 8 studies reported precision values ranging from 0.2% to 100%.Conclusions:AI and semiautomated tools primarily facilitate data extraction or collection and risk of bias assessment. The use of AI or semiautomated tools in LE synthesis improves efficiency, leading to high accuracy, recall, and F1-scores, while precision varies across tools.Trial Registration:OSF Registries 87tp4; https://osf.io/4fvdq/overview

Background Evidence briefs for policy (EBPs) are effective tools for delivering research evidence to policymakers and other stakeholders by highlighting high-priority issues, outlining options and considering implementation strategies. However, policymakers’ demands for evidence and policy-relevant information across different fields have led to variability in the terminology used to describe EBPs, and the methodological quality of these EBPs remains unclear. This study aims to (1) identify organizations whose definitions of EBPs contain the three key components of problem, options and implementation considerations, (2) assess the methodological quality of EBPs that incorporate these three key components and (3) identify existing evaluation/assessment tools of EBPs. Methods A two-stage documentary analysis approach was used. First, we identified documents that were produced by organizations/institutions to inform policymakers and that contained the three key components (Problem, Options and Implementation considerations). Second, the methodological quality of the documents was assessed from the perspectives of the evidence supply side (that is, evidence synthesis) and the evidence demand side (that is, mapping of and engagement between both policymakers and stakeholders). Results In 22 organizations, the term policy brief was the most commonly used, accounting for 50% of organizations, while other terms varied. Issue briefs were used by three organizations (13.6%) and evidence briefs were used by two organizations (9.1%). In total, 50 individual documents from nine different organizations were included to evaluate components and methodology. (1) From the supply-side perspective: 17 (34%) documents described the search resources, 10 (20%) documents described evidence certainty and 15 (30%) assessed the methodological quality of the research evidence. (2) From the demand-side perspective: 30 (60%) documents were developed in response to demand-side needs, while 27 (54%) included both stakeholder mapping and engagement. Conclusions Methodological shortcomings were identified in the EBPs from both the supply-side and demand-side perspectives, highlighting the need to validate and better implement existing tools and to complement existing guidelines.

Background An increasing number of systematic reviews (SRs) in the environmental field have been published in recent years as a result of the global concern about the health impacts of air pollution and temperature. However, no study has assessed and compared the methodological and reporting quality of SRs on the health effects of air pollutants and extreme temperatures. This study aims to assess and compare the methodological and reporting quality of SRs on the health effects of ambient air pollutants and extreme temperatures. Methods PubMed, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Web of Science, and Epistemonikos databases were searched. Two researchers screened the literature and extracted information independently. The methodological quality of the SRs was assessed through A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The reporting quality was assessed through Preferred Reporting Items of Systematic reviews and Meta-Analyses (PRISMA). Results We identified 405 SRs (286 for air pollution, 108 for temperature, and 11 for the synergistic effects). The methodological and reporting quality of the included SRs were suboptimal, with major deficiencies in protocol registration. The methodological quality of SRs of air pollutants was better than that of temperature, especially in terms of satisfactory explanations for any heterogeneity (69.6% v. 45.4%). The reporting quality of SRs of air pollution was better than temperature, however, adherence to the reporting of the assessment results of risk of bias in all SRs (53.5% v. 34.3%) was inadequate. Conclusions Methodological and reporting quality of SRs on the health effect of air pollutants were higher than those of temperatures. However, deficiencies in protocol registration and the assessment of risk of bias remain an issue for both pollutants and temperatures. In addition, developing a risk-of-bias assessment tool applicable to the temperature field may improve the quality of SRs.

To determine if aircraft noise exposure causes an increased incidence of hypertension among residents near airports. We conducted a meta-analysis of observational studies to evaluate the association between aircraft noise exposure and the incidence of hypertension. PubMed, Embase, Web of Science, the Cochrane Library, and the Chinese Biomedical Literature Database were searched without any restrictions. Odds ratios (ORs) with 95% confidence intervals (CIs) were extracted. The pooled ORs were calculated using both the fixed effects model and random effects model. All analyses were performed using STATA version 12.0 software (Stata Corporation, College Station, TX, USA). We examined five studies, comprising a total of 16,784 residents. The overall OR for hypertension in residents with aircraft noise exposure was 1.63 (95% CI, 1.14-2.33), and one of our included studies showed that there was no evidence that aircraft noise is a risk factor for hypertension in women. According to our subgroup analysis, the summary OR for the incidence was 1.31 (95% CI, 0.85-2.02) with I2 of 80.7% in women and 1.36 (95% CI, 1.15-1.60) with moderate heterogeneity in men. The pooled OR for the incidence of hypertension in residents aged over 55 years and under 55 years was 1.66 (95% CI, 1.21-2.27) with no heterogeneity and 1.78 (95% CI, 1.33-2.39) with I2 of 29.4%, respectively. The present meta-analysis suggests that aircraft noise could contribute to the prevalence of hypertension, but the evidence for a relationship between aircraft noise exposure and hypertension is still inconclusive because of limitations in study populations, exposure characterization, and adjustment for important confounders.